Provider Demographics
NPI:1407133382
Name:PEAK PERFORMANCE CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROHRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-232-9258
Mailing Address - Street 1:3221 EASTBROOK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5708
Mailing Address - Country:US
Mailing Address - Phone:970-232-9258
Mailing Address - Fax:970-232-9417
Practice Address - Street 1:3221 EASTBROOK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5708
Practice Address - Country:US
Practice Address - Phone:970-232-9258
Practice Address - Fax:970-232-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty